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Breast Reconstruction with Capsulectomy

  1. #1
    Location
    Adirondack Chapter of Professional Coders, Glens Falls, NY
    Posts
    26
    Question Breast Reconstruction with Capsulectomy
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    My provider often performs a capsulectomy (19371) before doing a breast revision (19380). Empire Blue Cross specifically will not pay for the 19371 because they state it is included in the 19380. However, I cannot find any documentation that either confirms or denies this, any thoughts?

  2. Default
    our office performs these procedures as well. there isn't a CCI edit when billing both codes together, but we bill one or the other. since there is a definitive code for a capsulectomy, i would go with 19371 - i.e. capsulectomy w/removal of implant/expander, ruptured implant w/in the capsule, etc. i'd also bill 19340 if another implant is replaced. we bill 19380 for removal of tissue/skin, capsulorraphy, or adjustments made in breast pocket.

  3. #3
    Default Capsulotomies with removed of tissue expanders and placement of implants
    If the physician performs extensive capsulotomies, removes tissues expanders replacing them with implants, and performs axillary liposuction -- 19370, 19342, 11970, 15877.

    Does 19380 include the capsulotomies? The way I read 19380 is that the physician is performing revision of breast where implants have already been placed. It talks about tissue rearranged and the existing prosthesis being replaced by a prosthesis of a different configuration.

    Any help would be appreciated.
    Last edited by JBowyer; 05-09-2012 at 09:59 AM.

  4. #4
    Default
    If the physician performs extensive capsulotomies, removes tissues expanders replacing them with implants, and performs axillary liposuction -- 19370, 19342, 11970, 15877.

    Does 19380 include the capsulotomies? The way I read 19380 is that the physician is performing revision of breast where implants have already been placed. It talks about tissue rearranged and the existing prosthesis being replaced by a prosthesis of a different configuration.

    Any help would be appreciated.
    __________________

    JBowyer

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